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JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold...

JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and...

Prime Staffing is seeking a travel nurse RN Research / Clinical Research for a travel nursing job in Fullerton, California. Job Description & RequirementsSpecialty:...

Nurse Appeals Location: Nashville Tennessee (This role is open only to residents of Tennessee). Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum...

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to...

The Virtual Nurse, RN at MUSC coordinates and delivers professional clinical, quality, and educational services to patients engaging with MUSC via virtual care. This role reports to leadership within the MUSC Center for Telehealth and aims to...

Float Health is seeking an Intake Specialist to manage new patient referrals and coordinate start-of-care visits. This externally facing role requires quick action, clear communication, and meticulous attention to detail to ensure timely,...

Delivering high-quality nursing care from a remote setting, the full-time Remote Care Nurse II will conduct patient assessments, develop care plans, and coordinate with multidisciplinary teams to optimize health outcomes using telehealth...

Nursing Attendant On Call Days (P)Under the direct supervision of a Registered Nurse or physician, performs a variety of patient care functions as assigned and in accordance with the legal scope of competency and within established standards of...

Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of...

Resp & Qualifications We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for...

Registered Nurse Locations: Los Angeles, California Job Category: Registered Nurse Position Type: Full-Time Shift: Evenings Job Description Join a team that's shaping the...

Centene Corporation is seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) for a remote case management role in Pennsylvania. The selected candidate will perform concurrent reviews, determine appropriate care levels, and assist with...

HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and...

Secondary Review Nurse At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.

Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization Various, NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they...

Explore opportunities with Amedisys, part of the Optum family of businesses. We provide home health, hospice and community-based services that help people receive quality care where they feel most comfortable: at home. Rooted in personalized care,...

Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling...

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer...

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Registered Nurse (Utilization Management) .Candidate must be authorized to work in USA without requiring sponsorshipLocation: 100% Remote for California...

Trustaff is seeking a travel nurse RN Clinic for a travel nursing job in Los Angeles, California. Job Description & RequirementsSpecialty: ClinicDiscipline:...

Fully Remote: Clinical Documentation SpecialistFacilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to...

Providence Tarzana Medical Center in Tarzana, CA is seeking a Certified Nursing Assistant for the Cardiovascular Unit. This Full-Time role requires CA Nursing Assistant Certification, BLS, and completion of the Nursing Assistant course, with...

CVS Health is recruiting for an RN Concurrent Review Nurse in a remote capacity, focusing on inpatient clinical expertise to ensure medically necessary care across the continuum. The role requires an active RN license and 5+ years of...